Thousand Of Veterans Had Their Claims Denied During the Pandemic

Speaker 1: 00:00 A new report finds veterans are struggling to file claims for VA benefits. During the pandemic KPBS, military reporter, Steve Walsh says many vets are being improperly denied because they cannot get to a doctor. Speaker 2: 00:15 Mark session got a late start. He was 34 years old when he entered Navy bootcamp, like many vets. He has lingering issues from his time in the service, especially with his back. He's been wrestling with the VA benefits process since he retired in 2017. This year during the pandemic, the real issue for the Chula Vista vet has been getting in to see a doctor Speaker 3: 00:37 I initially is scheduled in February and then it was, uh, rescheduled to September. And if it's timber to, um, October and then October, they finally scheduled a scheduled for November, Speaker 2: 00:53 Even in a normal year session says the VA claims process is long and exhausting. Speaker 3: 00:59 That was very frustrating because I want this whole situation to be over, you know, to finally not have to be worried about any more exams or having to contact my attorney and stuff like that is just, um, I just want to be done with it and get out of the way Speaker 2: 01:15 Beginning in April, the VA shut down all in-person appointments. Everything moved online, including doctors appointments, the backlog of exams ballooned to 1.5 million during the pandemic, a new report by the VA's inspector general also says thousands of claims were improperly denied this after VA leadership declared that no vet should have their claim denied because it wasn't safe to see a doctor. Speaker 4: 01:41 They didn't get the memo because there's so much happening Speaker 2: 01:43 Sessions. Attorney Casey Walker, once worked for the VA as he puts it. Some VA employees just didn't get the memo. Speaker 4: 01:51 And then you got to keep in mind at the same time. A lot of these, a lot of these employees work from home for the first time ever. Many of them not being too capable with their technology from home. They've always worked at the regional office. Their entire lives VA may require an in-person examination. As part of the claim. Speaker 2: 02:07 The da made the backlog worse Walker says by telling outside mental health providers that they could not evaluate their patients remotely. When it came to filling out VA benefit claims. At the same time, the VA was telling its own doctors and contractors to only see patients using telehealth. Speaker 4: 02:24 Then almost in the same month, they said, you must give mental health exam by tele-health means that about what gifts here. Speaker 2: 02:31 Yeah. His website shows nearly all of the country is open for in-person exams to some degree to chip away at the backlog of 1.5 million exams. Maura Clancy handles veterans benefits, appeals for Chisholm, Chisholm and Kirkpatrick, a national firm based in Rhode Island, which has clients in San Diego. I have noticed more Speaker 1: 02:52 Lamination reports coming in. So I know that they are working on the exams that were pending throughout pandemic. Speaker 5: 03:00 And so that's a start Speaker 2: 03:02 Instead of scheduling new visits, she says the VA should also lean more heavily on using existing medical records. At least for now, the VA told their inspector general that they are looking at cases denied during the pandemic. That shouldn't count on their cases being reopened. Clancy says instead, that should assume they'll have to step up on their own and file an appeal. Speaker 5: 03:24 Um, it only helps the, the case, I think, to be able to point to what VA's guidance was in the beginning of the pandemic, which was that the, those denials weren't supposed to happen. Um, and hopefully that they will take some corrective actions. Speaker 2: 03:39 The VA has been trying to clear away the backlog of benefits claims for years, a new law went into effect a year before the pandemic designed to speed up the process. According to advocates who helped guide veterans through the process, juggling the new system and the pandemic probably created more cracks in the system. Speaker 1: 04:00 Johnny May now is KPBS military reporter, Steve Walsh, Steve, welcome. Hi Maureen. You know, since it's been so hard to see a doctor during the pandemic, what kinds of claims are being denied by the VA? Speaker 2: 04:14 Well, you know, the report from the da inspector general didn't really get into the kinds of claims, but it sounds like it was pretty much everything across the board. Now, you know, this is the VA benefits process. The VA health administration usually gets most of the attention. That's the hospitals and the healthcare. This is the VDA. This is where a veteran goes in to file a disability claim. They get a rating, you know, showing that their percentage of disability and then the VA pays them a stipend. So, so the VA started getting complaints. They undertook, um, their own review of some 20,000 claims. They found like 84% of the claims were improperly denied in April. And, and, and back in March, that percent has started to drop in the following months, but they were still denying nearly half of these claims back in June. And this is after the VA, you know, sent out guidance in may, specifically telling staff not to deny these claims, just because people couldn't go see a doctor Speaker 1: 05:10 Under normal circumstances. What's the process to file a disability claim. Would the vet have to be seen by a VA doctor? Speaker 2: 05:18 Typically, that's how it goes. And most of the exams are called C and P exam. They're done by, uh, outside, uh, doctors contracted by the VA. Sometimes the VA does some of these themselves, but yes, you, you typically need to go see a doctor. They have to fill out these forms. The VA has very specific things. They're looking for. Actually, one of the other complaints I heard from one of the attorneys is just prior to the pandemic, the VA removed the forms from its websites, which made it harder for a private physician or even the vet's own doctor to perform these examinations exactly the way the VA likes to see them done. Speaker 1: 05:54 And wasn't any alternate or interim procedure put in place when in-person appointments were shut down last spring. Speaker 2: 06:01 Well, you got to remember back to the early part of the pandemic. Things were pretty hectic. Um, it looks like they did hold some training sessions back in March. They were encouraging staff to keep working from home and, uh, encouraging exams through tele-health though, according to the inspector general, uh, it looks like they realized early on that some of these appointments couldn't be done online. In fact, the real problem seems to be that not everyone followed the guidance that was coming from the top, from the beginning saying that, you know, go ahead and postpone. These claims do not deny them. And what happened is a whole bunch of people are going to have to start over if they don't follow this process on their own. Speaker 1: 06:43 Tell us more about the mixed messages the VA has sent out about mental health treatments. Why can't benefits be claimed after a remote assessment, by an outside mental health provider, when that's exactly what VA providers are doing, they're doing all their appointments and assessments through telehealth, Speaker 2: 07:02 Right? That's where the confusion came from. This is a real frustration among these attorneys. So it seems like the VA didn't seem to trust these outside doctors to do these assessments remotely. The VA wants all this very specific information on its claims. They really don't say what their reasoning was, but these are essentially zoom calls. You know, they have to follow a specific VA protocol. Some exams do require somebody to be in the room with the client to perform certain tasks. It may have just been a lack of trust on the VA's part. And when it came to outside doctors at the same time, yeah, they were rushing their own doctors and contractors into training so they could keep the system moving. You know, it created even more confusion and delay though. Speaker 1: 07:47 One of the attorneys you spoke with said, the VA could lean more heavily on existing medical records instead of scheduling new appointments. Can you explain what that means? Speaker 2: 07:57 Well, you know, these are veterans, so they have a very long medical history here dating all the way back to their time in active duty, the VR AR already does something called acceptable clinical evidence or these ACE exams where you essentially, you go through the, uh, the vet's medical records and review past information on there to determine whether or not you can already prove that they're either mentally or physically disabled without seeing a doctor. They do this normally. Um, and the VA told the inspector general that they are looking at doing that, but advocates say they could do so much more. And especially right now when people are very concerned that, uh, even if they can see a doctor that they may not want to right now, because they don't feel safe. Speaker 1: 08:42 As I say, you spoke to attorneys and they work with veterans and helping them secure benefits since so many veterans are having trouble claiming benefits. Should they just routinely get the help of a lawyer now? Well, lawyers would Speaker 2: 08:56 Say that, yes, that that's the case. So you got to understand this system in this system, the lawyers that basically act as what's called veterans service officers, some of these advocates are attorneys and, and, you know, they're paid for their services, but a service organizations like the American Legion or disabled American vets they'll offer free help. Even the County has their own veterans service officers. And yes, the VA does acknowledge that their system is incredibly complex, even on the best of days. And, and they acknowledged that people might want to turn to a veteran service officer to help them through the process. I know I've, I've talked to many vets over the years and it's very difficult to do this on your own. Uh, and, and there are certain deadlines that if you miss them, you're, you're going to be out a lot of money. Speaker 1: 09:45 I've been speaking with KPBS, military reporter, Steve Walsh, Steve. Thanks a lot. Thanks, Maureen.